Synergistic Bradycardia from Beta Blockers, Hyperkalemia, and Renal Failure

Simmons, Tristan; Blazar, Eric

doi:10.1016/j.jemermed.2019.03.039

Cited by 19 publications

(12 citation statements)

References 11 publications

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“…8 Evidence indicates that non-selective β-blockers are more commonly associated with hyperkalemia than the cardioselective ones. 9 However, there are some evidence that suggested the potential of selective β-blockers like metoprolol, 10,11 bisoprolol, 12 and atenolol 13 to induce hyperkalemia. 11,12 In the current study, both selective and non-selective β-blockers were included, where 38% (8) of β-blocker users developed hyperkalemia.…”

Section: Discussionmentioning

confidence: 99%

“…9 However, there are some evidence that suggested the potential of selective β-blockers like metoprolol, 10,11 bisoprolol, 12 and atenolol 13 to induce hyperkalemia. 11,12 In the current study, both selective and non-selective β-blockers were included, where 38% (8) of β-blocker users developed hyperkalemia. A recent cohort study showed a 0.28 mmol/l (95% CI 0.03-0.53, p=0.031) increase in serum potassium level was associated with co-trimoxazole use compared to ceftriaxone use.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Incidence of Co-Trimoxazole-Induced Hyperkalemia in a Tertiary Care Hospital

Adawi

Albu-Mahmood

Abdelgelil

et al. 2021

RMHP

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Background: Co-trimoxazole is a broad-spectrum antibiotic associated with hyperkalemia. Objective: To determine the incidence of hyperkalemia and its risk factors in patients receiving co-trimoxazole. Materials and Methods: A retrospective observational study involving all patients who received co-trimoxazole between 1 January 2012 and 1 January 2013 was conducted. Subjects were identified through a list generated from a computerized pharmacy system. The patients' demographic and clinical characteristics were retrieved from electronic medical records. Data were analyzed using univariate and multivariate logistic regression. Results: One hundred sixty-one patients fulfilled the eligibility criteria. Of these, 46 (28.6%) experienced hyperkalemia. Around 35 (76%) of the patients who experienced hyperkalemia received co-administered medications that might induce hyperkalemia. The coadministration of co-trimoxazole with other medications that may induce hyperkalemia was found to be associated with higher incidence of hyperkalemia when compared to cotrimoxazole administration alone [adjusted OR 3.2, 95% CI (1.4-7.3), p=0.005]. Additionally, age > 60 years was associated with an increased risk of hyperkalemia when compared to younger age group 18-39 years [adjusted OR 6.5, 95% CI (2.1-19.7); p=0.001]. Conclusion: Co-trimoxazole use is associated with high incidence of hyperkalemia, especially among older patients and those receiving it in combination with other medications that might contribute to hyperkalemia development such as calcineurin inhibitors and β-blockers.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence of Co-Trimoxazole-Induced Hyperkalemia in a Tertiary Care Hospital

Adawi

Albu-Mahmood

Abdelgelil

et al. 2021

RMHP

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“…En la hiperpotasemia pura los niveles de potasio presentan la tendencia a ser mucho mayores para provocar arritmias o bloqueos AV, así como cambios electrocardiográficos. Niveles entre 6.0-6.5 mEq/l típicamente se asocian a ondas T picudas, mientras que niveles cercanos o mayores a 8.0 mEq/l se relacionan con bradicardia severa y arritmias malignas tales como fibrilación ventricular o taquicardia ventricular 1,3,7 . Por otra parte, se ha observado que en el BRASH niveles séricos de potasio cercanos a 5 mEq/l son suficientes para generar bradiarritmias.…”

Section: Discussionunclassified

Síndrome BRASH: A propósito de un caso acerca de un fenómeno sinérgico

Moya-Álvarez¹,

Hernández-Solano²

2021

REIE

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El síndrome BRASH (la combinación de bradicardia, insuficiencia renal, fármacos bloqueantes del nodo atrioventricular, choque e hiperpotasemia) es una patología recientemente descrita, la cual se confunde frecuentemente con una bradicardia o hiperpotasemia aislada. Según la literatura, este es uno de los errores más comunes y que mayor impacto negativo ofrece sobre el pronóstico del paciente. La piedra angular de este síndrome es la sinergia entre todos los factores que lo componen, por tanto, la literatura refiere que el clínico debe enfocarse en la identificación y el manejo de todos estos de manera simultánea. El tratamiento recae fundamentalmente en el manejo pronto de la hiperpotasemia, así como la resucitación con fluidos; y en algunas ocasiones se necesitarán métodos más avanzados de manejo, como antídotos para revertir el efecto del betabloqueo o calcioantagonistas, entre otros. Presentamos el caso de un hombre de 84 años que cumple con todos los criterios para el diagnóstico de este síndrome y en el cual el reconocimiento temprano tuvo impacto positivo en la evolución y el pronóstico de este.

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“…It was noticed that many clinicians have not clearly mentioned this clinical presentation as BRASH syndrome. Nine cases were identified in seven different studies [2][3][4][5][6][7][8]. The age of presentation ranged between 24 and 97 years with the mean age of 72 years.…”

Section: Discussionmentioning

confidence: 99%

Bradycardia, Renal Failure, Atrioventricular-nodal Blocker, Shock, and Hyperkalemia Syndrome Diagnosis and Literature Review

Sattar

Bareeqa

Rauf

et al. 2020

Cureus

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The combination of bradycardia, renal failure, atrioventricular (AV)-nodal blocker medications, shock, and hyperkalemia (BRASH) is a new syndrome that is a consequence of a positive loop of bradycardia due to AV-nodal blockers and hyperkalemia secondary to renal insufficiency. We present a case of BRASH syndrome in which the patient on chronic AV-nodal blockers presented with bradycardia, hypotension, underlying kidney dysfunction, and hyperkalemia. The patient was medically managed and discharged upon clinical improvement. The purpose of this report is to highlight the rare cases of BRASH syndrome and improve its management.

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Synergistic Bradycardia from Beta Blockers, Hyperkalemia, and Renal Failure

Cited by 19 publications

References 11 publications

Incidence of Co-Trimoxazole-Induced Hyperkalemia in a Tertiary Care Hospital

Incidence of Co-Trimoxazole-Induced Hyperkalemia in a Tertiary Care Hospital

Síndrome BRASH: A propósito de un caso acerca de un fenómeno sinérgico

Bradycardia, Renal Failure, Atrioventricular-nodal Blocker, Shock, and Hyperkalemia Syndrome Diagnosis and Literature Review

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